Photographer:Fotograaf: Joey Roberts/ Simone Golob
It is not just the medical students who often see GPs as “middlemen”, says GP and researcher Jochen Cals. Many patients think the same.
Daily practice is completely different. “Research shows that we deal with almost 95 per cent of the complaints ourselves, even the complex cases. It is only the tip of the iceberg that ends up seeing a specialist: a patient suspected of having cancer is referred to an oncologist, and one who has a heart attack goes straight to the cardiologist. Those specialists go the whole hog – tests, scans, blood tests, x-rays, deliberations with colleagues – in order to arrive at the correct diagnosis and provide a suitable treatment. Co-operation with them is extremely important for us, because they take care of issues that the GP in not able to deal with, let there be no mistake about that.”
But at the hospital, everything revolves around 'disease', the medical complaint, while the GP is much more about both 'disease' and 'illness'. “Illness refers to how the patient experiences his/her complaints, disease and daily worries. It is the GP who observes the whole story of disease, personality, family, work and daily life, and adjusts the treatment accordingly.”
The GP gains insight into the patient’s life partly through surgery visits for their common colds, infected toes, itches, eczema, and fears. “More often than not these are non-serious disorders, easily remedied. The contact during these types of visits is very important. You get to know the family, know how things are at home and at work, you notice whether someone becomes anxious easily, or is more inclined to underplay the complaint. That picture is important in making the right decision. For example, if the patient who makes light about his complaints is sitting across from you because he is worried about pressure on the chest, then you know you have to be extra alert. ”
The GP has to make a decision on the basis of relatively little information – the patient’s story and a physical examination, Cals emphasises. “We have to deal with a lot of uncertainties.” Add to that the fact that many of the people in his waiting room suffer with several chronic complaints. “We call that multimorbidity. People don’t just have a ‘busted’ knee, but also diabetes, high cholesterol levels and problems with their hearts. This complexity is the most difficult of all: you have to adjust everything to everything and ensure that the solution for complaint A does not have a negative effect on complaint B. A specialist shows what is going on in his field – again, that is very important. Our worlds complement each other completely – but together with the patient, we look at the whole picture and in medical terms, that is often much more complicated. Specialists also acknowledge this.”
Lastly: what is true about the popular idea that GPs know a little bit about everything? Very little, says Cals. “We have to be able to recognise the signs in all fields. I don’t need to treat MS or intestinal cancer, but alarm bells do need to sound when I observe certain symptoms. That is very complex, especially at an early stage when symptoms are not very pronounced.”
This is a series in which academics shoot down popular myths